Menopause & BHRT

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Pre-menopause, Peri-menopause, and Post-menopause – The Difference of having BHRT

Women experience many changes in the body that our minds have to understand and process. Menopause is one of them. While it is a normal part of a woman’s life, there are still areas that confuse some people, such as the difference between pre-menopause, peri-menopause, post-menopause and menopause itself.

If you are concerned about these, including the signs and symptoms of menopause and what it means when you experience it, then it is time to get educated. Below are the basics about pre-menopause, peri-menopause, and post-menopause, as well as frequently asked questions about them.

Remember, the first step in understanding these events (changes before the change) in women’s lives is learning what they are and how they might affect an individual.


You may have heard of menopause before, but these three words may be new to you. So, here are the differences between PRE-MENOPAUSE, PERI-MENOPAUSE, AND POST-MENOPAUSE.


Pre-menopause and peri-menopause may seem like very similar terms, as they are sometimes used in place of each other. Medically, the prefix “pre” means “before”, so, deriving from this definition, a woman in pre-menopause means a woman before she enters menopause.


If you are wondering when it happens, just think of it as the period of time that comes before and after menopause itself. In fact, the prefix peri- means near or around. Added to the word menopause, it means the stage or process of change that leads up to menopause and after menopause. It can start as early as the late 30s or as late as the early 50s. In some countries, it occurs between ages 45 to 55, and may last one to four years. But its actual duration varies from one person to another. In some cases, it can last as little as a few months, but other times it may last as long as a couple of years.

Sometimes called the “menopause transition”, perimenopause is the stage when a woman usually starts having irregular periods, hot flashes, or other symptoms, because the hormones begin to fluctuate, or go up and down. Each month the periods become more irregular, and different symptoms may or may not show up until they are on the way to full menopause.

However, keep in mind that if you are in peri-menopause, the symptoms you may have can be highly variable during this time. The most common perimenopausal symptoms may include changes in period cycle, hot flashes, mood swings, and sleep disturbances.

What hormonal changes occur during perimenopause?

During a woman’s monthly cycle, the body produces two primary hormones – estrogen and progesterone. Both of these hormones are produced from the cells which surround the eggs.

The estrogen helps the uterine lining to grow, and the progesterone soars when the egg is released during ovulation. Progesterone (the ovulation hormone) also works for pregnancy and is also an essential hormone to control the uterine lining’s growth.

When there is too much estrogen (period of excess estrogen), the menstruation can become too heavy, too long, or erratic. Bloating and breast tenderness may also be experienced, as well as headaches. On the other hand, too little progesterone (period of progesterone deficiency), and the uterine lining can become thicker, causing heavier menstruation.

In essence, estrogen is what makes the endometrial (uterine) lining thick, like what fertilizer does for grass. On the other hand, progesterone works the opposite role, it’s like a lawn mower that cuts the grass.

Sometime during the menopausal transition, the estrogen levels decrease, and the endometrial lining then becomes thinner. Moreover, the ovulation becomes infrequent (which is why a menopausal woman can’t conceive). In the last years before bleeding stops or during the final menstrual period, the periods become more infrequent, lighter, and then finally ceases. This is a time of estrogen deficiency.

What are the possible symptoms of perimenopause?

The signs and symptoms of peri-menopause vary depending on which hormones go up or go down. Changes in these hormone levels can affect women differently and cause varied physical or emotional symptoms.
Here are different possible combinations of the peri-menopause symptoms below, and to varying degrees per hormone issue:

Estrogen Excess Symptoms

  • Bleeding (erratic, too long, too much, too soon)
  • Bloating
  • Breast tenderness
  • Headaches
  • Vaginal discharge
  • Weight gain

Progesterone Deficiency Symptoms

    • Bleeding (Heavier flow than usual, premenstrual spotting, shorter cycle than usual)
    • Premenstrual Syndrome (PMS) – often seen during pre-menopause
      • Anxiety
      • Depression
      • Difficulty concentrating
      • Hot flushes
      • Irritability
      • Menstrual migraine or headaches
      • Moodiness

Pre-menopause and peri-menopause may be confusing at times. Some used them interchangeably, but technically, pre-menopause and peri-menopause have different meanings.


Post-menopause, also known as the full menopause stage, is when a woman has not had a period for twelve months and the rest of the years after going through menopause. During this stage, estrogen levels decrease and some menopausal symptoms may ease and cease for many women. But, some individuals may still experience dry skin, low libido, mood swings, and vaginal dryness.

As a result of lower estrogen levels, women in the post-menopausal stage are at an increased risk for several health conditions, including osteoporosis or heart disease. Medications and supplements, such as hormonal therapy and/or specific healthy lifestyle changes, may help prevent these conditions or reduce the risk at least. Since every woman’s condition, overall health, and risk factors are different, it is better to talk to a primary physician to know what specific steps to take to reduce individual risk.


It can be very difficult to know which treatment option best suits an individual experiencing either premenopausal, perimenopausal, or postmenopausal signs and symptoms such as hot flashes, night sweats, muscle pains, and other troublesome manifestations. If you experience any of these symptoms, you should contact your primary health-care provider to discuss their effects and possible treatment options. Many of the associated symptoms are manageable, and there are several treatment options that would work best after a thorough assessment. You can talk with your current healthcare provider or family physician, and based on your signs and symptoms, medical history, and treatment goals; you can come up with a solution.
Here are some of the possible treatment options for hormonal issues associated with premenopausal and menopausal symptoms:

Hormone Replacement Therapy

Hormone replacement therapy, sometimes called HRT, is a treatment option to help regulate hormones. Some family physicians can offer the treatment options for moderate to severe signs and symptoms of perimenopause or menopause.
If you haven’t heard of HRT before, it simply means taking medication that contains female hormones, such as estrogen. Dosages of estrogen during hormone replacement therapy range from ultra-low levels to standard and, at times, higher doses depending on the physician and needs of the client.

Hormone replacement therapy can help relieve symptoms, such as hot flashes and other troublesome effects of fluctuating hormonal levels. In some cases, clients choose to undergo hormone replacement therapy to help control the symptoms of vaginal atrophy or the drying, thinning, and inflammation of the vaginal tissues and urethra that is caused by the body’s low levels of estrogen.
Benefits of HRT and BHT:

  • Can address symptoms such as hot flashes and night sweats
  • Help relieve symptoms of depression for some users.
  • Improved concentration
  • May aid in improving sleep quality resulting in less fatigue and irritability
  • May prevent bone loss, reducing joint pain and the risk of osteoporosis and fractures.
  • Shown to provide some protective benefit to the development of cardiovascular problems such as heart disease

Possible effects of HRT :

  • Bleeding in the abdomen
  • Breast tenderness
  • Headache
  • Nausea and retching
  • PMS-like symptoms (Premenstrual syndrome)
  • Retention of fluid
  • Uterine bleeding
  • Bioidentical Hormone Therapy (BHT)

Bioidentical Hormones

Bioidentical Hormones are exactly what their name implies – compounds that are identical to the natural molecules that your body produces. These are not chemicals made from animal waste, rather, they are formulated from soy products or yams, by pharmacists to match your body’s hormones identically. Through Bioidentical Hormone Replacement Therapy, patients are likely to experience the benefits of the human hormones, without the side-effects associated with chemical hormones.

The dangers of using man-made compounds, such as Provera and Premarin, to serve as a hormone substitute are reported in the literature. They are intended to supplement the hormones that naturally occur in your body. Premarin is made from the pregnant mares’ urine (as in horses). It contains estrogen (estrone), but it also contains a number of horse estrogens that are not found in humans. Women’s health study reported a number of adverse side effects, such as increased risk of breast cancer, stroke, and heart problems with the combined use of Premarin and Provera known as Prem- Pro.

The levels of the hormones Progesterone and Estrogen and testosterone (in women), and Testosterone (in men) tend to decline with age. However, just because the body doesn’t make as much, doesn’t mean that you don’t need them!

Fortunately, there is a safe alternative to potentially dangerous man-made compounds – Bioidentical Hormone Replacement Therapy, or BHRT. Dr. Patel, specialist in Neuro- immune – endocrine disorder, specializes in bioidentical hormone replacement therapy for patients in Buffalo,Amherst, Cheektowaga, Williamsville, NY and the surrounding area.

  • Experienced physicians who understand biochemistry of hormones and how it is metabolized in the body, will give you BHRT in the correct amount and will perform special urine tests to see how you are metabolizing, meaning it does note in females all hormones including testosterone be addressed.
  • Long term follow up is essential.
  • Dr Patel provides different treatment options for BHRT. Creams- gels – pellets
  • Hormonal Support Supplements are also essential for optimal metabolism.

Hormonal support supplements have been made available for women experiencing hormonal changes for quite some time now. They can be very beneficial in supporting the correct processing of hormones and reduce some of the negative physical and mental signs and symptoms of hormonal imbalances.

Our goal is to provide optimal success to our treatment. Finally you feel young again!


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